You are blindly defending ObamaCare. Yes, it has some good parts, but it barely addresses the cost issue (there is 10B in it to study per patient instead of per procedure procedure payments). People like myself are bearing the cost increases. For example, my family could be making another house payment with our premium for a high deductible plan.

Again, if it was the reform that many expected in 2008, we would see premiums going down at this point.

Fire departments exist solely for emergencies and are paid by tax dollars.

Why couldn't we do the same thing with emergency rooms?

Interesting idea. And it could still be attached to a hospital that it was independent of, in terms of patient billing, but I see a lot of potential red tape and regulations at that interface between the two, to prevent the hospital from exploiting it in some way or another.

Can "you" handle the truth.
This is a free market capitalist economy.
How dare anyone criticize private business.
Next "you" will want government interference & regulation.
So let's regulate whatever business "you" work in. If anyone complains
about the price,the price must be reduced.Sorry if you lose your income.
To summarize, IF YOU CAN"T PAY CASH,YOU ARE A FAILURE!
This is America,fuck other countries.
Hypocrisy is strong in all of us.

If you split the emergency from the elective, then people could shop best Price and Quality for the Elective Care while the price for Emergency would be subject to cost controls.

If you split the commercial from the investment, you cut easily cut off the CDs and checking accounts and lines of credit from the IPOs and Bundled Securities, saving Main Street while making Wall Street eat their own shit if they fuck up.

The reason the insurance/hospital industry doesn't want emergency care and elective care split apart is because they can use emergencies as leverage to support the cost of elective; just like Wall Street holds main street hostage by entwining commercial and investment banking. "Bail out our MBS derivatives or Grandma's Savings Account and Bill's Auto Care Line of Credit gets it!"

ObamaCare with its high costs has been responsible for a large portion of GDP growth. That's why everyone is afraid to take it away. Make medical procedure prices reasonable and see economy go into recession.

I once asked Professor Ikegami why doctors put up with this; why don’t they just refuse to take MRI scans if the fee is so low? “The answer to that is the Fee Schedule,” the economist replied, “There is only one payment scale in Japan. If a doctor won’t accept the price in the schedule, he won’t get any business. And he won’t have the scans he needs to diagnose his patients. So the doctors accept the price.”

As it turns out, the heavy-handed price control from above has had a salutary effect on the cost of medical care. Because the permitted fee for an MRI scan is so low, for example, Japanese doctors went to the MRI manufacturers–Hitachi, Toshiba, etc.– and demanded a new line of compact, inexpensive MRI machines. The industry responded. Today, Japanese doctors and clinics can buy MRI scanners for around $150,000– about one-tenth the price of the bigger machines used in the United States.

Notice how neatly the 1/10th of the price of machines translates into 1/10th the price of scans. Ass, gas, or grass no one rides free.

Can you say price controls and subsidies? Public health care? Funny how same people bitching about the price of health care scream they will never accept public health care. You can't have it both ways. When do you think the medical equipment industry will stop lobbying to keep these cheap and low profit MRI machines out of the US? Like never I would think. Nothing like good old fashioned bought and paid for crony capitalism. Oh my, most of that lobbying money goes to republicans. Draining the swamp I see.

Surgery Center of Oklahoma is an interesting example of removing the corrupt iinsurance rackets from the pricing of medical service. By refusing all insurance, and being strictly cash-and-carry, are able to post flat rate pricing:https://surgerycenterok.com/pricing/

That's the big reason. They won't even take credit cards. By being cash and carry, that eliminates a HUGE chunk of their overhead, a billing staff. Not having to pay wages to a whole department of paper pushers, then waiting months to get paid, they're passing on the savings to the people.

The question is, how many people have CASH to pay for their medical procedures, when over half of the country doesn't have $400 saved up for an emergency?

Very good, you are actually making a valid point about where some of the big costs of health care come from instead of just regurgitating the libertarian mantra we need more insurance company competition to reduce costs. Health insurance is a huge part of increasing the cost of health care, not reducing the cost. Are you sick?

Doctors in New York years back tried to band together and provide a network of coverage for a family for $600 per person for the year. You pay up front for the year and could see anyone within their network. They were shut down by the state because the state claimed they were running an unlicensed insurance program. The real reason the state shut them down is because if that were allowed to happen, it would put every insurance company out of business.

Here it is, "If my insurance isn't paying for it, I'm not getting it". This even came from people who had zero problems paying cash for it.

Reading comprehension problems again? Read the article, not that you have ever read anyone's link before but there is always a first time. The out of pocket cost using insurance is higher than just paying cash and not using the insurance at all.

Fix it? There is no fix for the US health care system where I believe it should be true is the only criteria people use for making choices. When people don't have the vaguest clue the difference between the cost of health care and the cost of health care insurance then you end up with an abortion like ACA rather than solutions that actually reduce health care costs. There is so much profit in the system that any attempt to fix it, as in actually reduce costs and profits, will be overwhelmed by lobbying money very quickly.

Wow, that is amazing! I have never seen any medical center price list before. Excellent. I hope others follow suit.

If you follow links from the Oklahoma site they are a member of an organization that does this:http://fmma.org/
You can use that website to find a place near you, if one exists. There is one in York, PA, but it seems to only be an orthopaedic care specialty.

When Nancy Surdoval, a retired lawyer, needed a knee X-ray last year, Boulder Community Hospital in Colorado said it would cost her $600, out of pocket, using her high-deductible insurance, or just $70 if she paid cash upfront.

When she needed an MRI to investigate further, she was offered a similar choice—she could pay $1,100, out of pocket, using her insurance, or $600 if she self-paid in cash.

Rather than feel good about the savings, Ms. Surdoval got angry at her carrier, Blue Cross Blue Shield of Arizona. “I’m paying $530 a month in premiums and I get charged more than someone who just walks in off the street?”

...

Finding the negotiated rates for those same services is tougher, since many insurance contracts bar payers and providers from disclosing them. But individual plan members can see that information on their Explanation of Benefit statements, so ClearHealthCosts has joined with public radio stations in New York, California and Pennsylvania, asking listeners to anonymously post what their health provider charged, what their insurance paid and what they paid out of pocket. Thousands have responded, showing that in many cases, while insurers had negotiated a big discount off the provider’s original charge, the negotiated rates were still higher than the service would have cost in cash at the same place or nearby.

When we compare prices, there are lot of factors. We should also compare average pay for doctors, and average income with cost of surgery for those countries.
Doctors can live happily with 30K in india but in US that is poverty rate.
e.g. in Japan MRI costs 160 but it is done by technician and doctor is not involved vs US where tech takes MRI but doctor will diagnose based on images.
How big is the rental cost differential for facility? Can client who gets MRI, sue and destroy the MRI facility for an error? so high insurance cost. Are they using same equipment newer and better equipment cost more. US has lots of regulations, each extra step cost more money. Does Japan charge cost thru taxes, hence actual cost is subsidized. indirectly it costs same money to citizen since govt takes and redistributes money.

Singapore diverts around 5% of income into a health savings account controlled by the individual. Seems to work very well there.

Not true. The Singapore system is far from a health savings account. There are multiple levels of health care accounts based on income. There is tight government control of spending of hospitals and providers. The government controls what medical procedures the individual can spend on. The contribution rate is 20% employer and 16% employer. The system certainly works well, but it is complex and very tightly managed by the government at all levels. Read Affordable Excellence by William A. Haseltine of the Brookings Institute. It documents the system very well, but is a very dense 170 or so pages that I found to be a bit of a slog.

Singapore scheme works like this (I live here and participate in this scheme):

37% of salary up to a max of 51,000 USD goes into a special account called CPF (essentially a retirement savings account).
Employees contribute 20% and Employers contribute 17%. 21% of 37% goes in to medical account. That means about 7.77% of the first 51,000 USD of salary.
Money goes in pre-tax and it earns approx 4% interest compounded monthly. Money in the fund gets divided into: savings and medical. You can take money out of the medical account and pay for large procedures and medical check ups.

Singaporeans does not receive much additional government support. The government is also fiscally very tight. In the past ten years, the government budget had surplus each year except for 2009 and 2015. In 2016, surplus was 1.3% of GDP. http://www.tradingeconomics.com/singapore/government-budget

The money going into CPF is managed by an entity called GIC. They have bought a lot of commercial real estate around the world, including USA. They are a big player for hard assets around the world. There's another government entity called Temasek. They invest in higher-risk situation and their investments goes toward generating the government budget surplus. Temasek got it's money from listing government owned assets, like telecom, port, subway systems and etc. Then they invested abroad and pioneered the concept of sovereign wealth fund.

It's a fascinating government design. Very corporate: efficient and profit focused.

Republicans will love it here. There's no capital gains tax and very very minimal social welfare, almost none. Corporate tax is low. However, there is a huge tax on car ownership. This is done in the name of reducing traffic jams. But the public transport is so good that you don't need a car. I have gone 11 years without having a car.

The important thing to report from Singapore is the excellent medical services that can be purchased at reasonable prices (relative to USA, Singaporeans bitch and moan about the high cost of living in Singapore). Btw: Singaporeans also mostly hate the CPF. They don't like having so much money being restricted by the government.

Back on track:
For example: Cost of a non-ceasarian delivery: approx 6000 dollars for high end stuff: private rooms, etc...
Cost of GP visit - 40 dollars
Knee Surgery: 15,000 USD (how much in USA?)

My daughter broke her arm and got x-rays and series of consultations. Total cost was about 750 USD.

All of this has to be paid out of pocket, so "the market" found ways to adjust. Part of the problem in USA must be because of:

For example: Cost of a non-ceasarian delivery: approx 6000 dollars for high end stuff: private rooms, etc...

Cost of GP visit - 40 dollars

Knee Surgery: 15,000 USD (how much in USA?)

My daughter broke her arm and got x-rays and series of consultations. Total cost was about 750 USD.

All of this has to be paid out of pocket, so "the market" found ways to adjust.

There are very successful public health care systems out there. There are also some continually underfunded disasters like NIH in Britain.

Of the 5 health systems I've had experience with I like NZ best. You get good care for the money with the least hassle. All are far from perfect. In NZ the top income tax rate is 33% and I paid about 24-26% nominal. That was total income tax for all government services. Health care, low cost college, roads, police, military, legal system, retirement, etc.,etc.. That's vs 23-24% nominal income tax I pay in the US plus 7.65% fica, plus 5-6% state (which through the miracle of AMT I can't write off) with no health care at all.

NZ cost of gp 25-30 USD.
Everything else cost is 0.
No there aren't endless waits or death panels. Drugs are evaluated for cost vs effectiveness then bought in bulk by the government at a low negotiated rate. Expensive procedures are done on a regional basis so there isn't tons of expensive equipment sitting around underutilized. You might have to travel for a complex procedure. When I had a heart mapping and ablation the health system paid for my airfare (sitting in the copilots seat of a cessna 172, I was in a very rural area), hotel, taxi's, and even airport parking.

What is missing is:
the cost insurance companies selling and billing for policies (since taxes are collected anyway there is no additional cost for collecting health care taxes)
the cost of and inherent conflict of interest in pay by procedure (gp's get capitation, specialists are employees of the health system)
the huge cost of doctors negotiating with, billing, and getting paid by the insurance companies (doctors offices don't have any billing staff at all, just a receptionist and nurse(s))
the cascading profit markup on every single procedure or item
profits to insurance companies/hospitals/labs/drug companies/hmo's/etc./etc./etc.,
lawsuits (there are no lawsuits in NZ, lawyers have to actually practice law)
the amount of money spent lobbying politicians by insurance companies/hospitals/labs/drug companies/hmo's/etc./etc./etc.
the list goes on and on.

All of this adds directly to the cost of health care. The vast majority of Americans have no idea were the money is going because they don't know the difference between the cost of health care and the cost of health care insurance. They only know the political talking points of whatever party they follow.

The US health system and political system are both a disaster that can't be fixed. For the same reason. The ever increasing ability of wealthy people and corporations to spend large amounts of money to influence the process to their advantage. Parliamentary systems are messy, but it's difficult to have a large political influence financially since you don't know what the majority coalition will be.

AMERICA!ns want to be bankrupted and shot in the face instead of being subject to marxism and enslavement by the state, objectives that make AMERICA!'s the most admired health care system in the world.

As Patrick has said, full price transparency by every provider would do miracles in bringing down the price of healthcare. Focusing on the payer side is stupid...that will naturally follow as provider prices plummet. I believe Rand Paul's plan comes closest to accomplishing this.

The US health system and political system are both a disaster that can't be fixed. For the same reason. The ever increasing ability of wealthy people and corporations to spend large amounts of money to influence the process to their advantage.

So true.

Your entire post - one of the best/most informative I've read on PatNet.

Republicans would love a 37% tax rate for a medical system totally controlled by the government?

Did you actually read what xyliang wrote? The part that goes into the medical fund is only 7.7% (of the first 50K salary).

True, I meant to type system not medical system. However It is all intertwined. I still don't think the republicans would go for 7.7% and total government control. He also didn't discuss what happens if someone doesn't have enough in the account to cover a major medical event. Read Affordable Excellence if you want to know how the whole system works in detail.

As Patrick has said, full price transparency by every provider would do miracles in bringing down the price of healthcare.

Feel free explain how this miracle will happen in detail since the vast majority of people have their medical bills paid by a third party. The information is out there on the internet already and I don't see any miraculous bringing down of the price of healthcare.

Actually price agreements between insurers and providers are highly confidential.

You can sort-of find out some prices that insurers pay and some prices that the uninsured public pay, but it's a very long way from transparency.

The miracle will happen,if people shop around

if people shop around

So what is going to inspire huge numbers of people to shop around when the insurance company is paying anyway? A question that never is addressed by the price transparency cult. Just the chanted mantra of price transparency, price transparency.

Most people choose a doctor by recommendation of someone they know or the closest doctor to them off the insurance company list of doctors. If people did somehow miraculously find the inspiration to shop around the odds are very high are the cheaper doctor won't be on the same insurance plan. What then?

I;m not against price transparency, but it's not going to save much if it happens. Unless human nature changes also.